INTESTINAL

OBSTRUCTION
DR.P.J.ALAGOA,
B.Med.sc,MB.BS,FMCS,FICS.
NIGER DELTA UNIVERSTY
 Stoppage of the onward passage
of intestinal contents – gas,
digestive juices & food.
 Types of intestinal obstruction
1. Mechanical (or dynamic) ileus –
due to mechanical obstruction of
the intestinal canal. Usually
associated with abdominal pain.
2. Paralytic (or adynamic) ileus –
results from paralysis of the
intestinal musculature. Usually
painless.
 Other classification:
- Congenital (e.g imperforate anus)
- Acquired
TYPES OF MECHANICAL OBSTRUCTION
1. Acute – of sudden onset
2. Chronic – of slow, progressive severity
3. Acute –on-chronic - chronic obstruction
suddenly becoming acute from obturation
of an already narrowed lumen
CLASSIFICATION BASED ON SITE
 Using the ampulla of vater as
reference
1. High – near the ampulla of vater
(jejunum &proximal ileum). Rapid &
early loss of fluid & electrolytes.
2. Low – (distal ileum & colon). Late
onset of fluid & eletrolytes
BASED ON NATURE OF
OBSTRUCTION
1. Simple obstruction – Only bowel
lumen is occluded e.g. obstruction
from worms,gallstones.
2. Strangulation obstruction: e.g.
obstructed inguinal hernia. There is
occlusion to the lumen + vascular
compromise to the intestine
3. Closed loop obstruction – the
obstructed loop is closed at both
ends.
PATHOPHYSIOLOGY
 DISTENSION – accumulation of gases &
fluids (Nitrogen -70%, carbon dioxide 6-
9%, Oxygen 10%, hydrogen 1%, methane
1%,hydrogen sulphide 1-10%).
 Gases from swallowed air, putrefaction &
fermentation of intestinal contents by
bacteria
 Absorption of Na, K & water decreases
 Vomiting soon occurs
 Increased peristalsis
 Intraluminal pressure increases in SI from
2-4mmHg to 10mmHg (25mmHg in the LI).
 When intraluminal pressure is higher
than venous pressure, it causes
venous congestion, oedema of the
wall & outpouring of fluid from
plasma into the lume of the gut &
peritoneum.
 Blood supply is undermined
 Fluid is lost by sequestration &
vomiting
 Hypovolaemia from loss of ECF
 Metabolic acidosis or alkalosis
Clinical features
 Pain
 Vomiting
 Absolute constipation
 Distension
 Visible peristalsis
 Scar
 Rebound tenderness
 General examination signs
 urine
INVESTIGATIONS

 Plain X-ray of the abdomen (erect

& supine)
 E/U/Cr
DIFFERENTIAL DIAGNOSIS
1. Paralytic ileus
2. Acute pancreatitis
3. Typhoid perforation
4. Severe constipation – impacted
faeces
TREATMENT
 NGT
 Correct fluid & electrolyte &
Metabolic imbalance
 Catherize
 CVP line
 Iv line
 Antibiotics
 Analgesics
 Surgery
CAUSES OF MECHANICAL
OBSTRUCTION
 Intraluminal
1. Ascaris
2. Foreign bodies
3. Pedunculated tumours
4. Impacted faeces
 Intramural – in the wall
1. Atresia
2. Anorectal anomalies
3. Intussusception
4. Tumours
5. Inflammatory lesions- divertiulitis, crohn’s
disease
 OUTSIDE THE WALL
(EXTRALUMINAL)
1. Strangulated hernia
2. External constrictios
(adhesions & bands)
3. volvulus